# Video DOT and Economic Incentives to promote adherence to LTBI therapy

> **NIH NIH R01** · JOHNS HOPKINS UNIVERSITY · 2021 · $811,650

## Abstract

Tuberculosis (TB), a highly contagious disease caused by Mycobacterium tuberculosis, remains a major public
health concern in the United States. Identifying and treating individuals with latent TB is a key strategy to
achieve the goal of TB elimination in the US but there are many challenges to achieving this goal. In
Baltimore, where this research will be conducted, more than one-third of non-US-Born individuals have latent
TB, and they are disproportionately affected by co-morbidities that increase the risk of progression to active
TB, such as diabetes and HIV. However, socioeconomic factors such as poverty, access to care, health
literacy, and language or cultural barriers present obstacles to treatment. Treatment for an asymptomatic
condition, such as latent TB, is rarely a priority for patients with many other competing needs. The length of
treatment (several months for standard “short-course” regimens) is also problematic, particularly for patients
experiencing housing or financial instability. Therefore, the majority of individuals infected with latent TB do not
complete treatment. We propose to evaluate novel and scalable smartphone enabled interventions to promote
completion of treatment for latent TB. Video-directly observed therapy (vDOT) provides multi-faceted
adherence support by allowing real-time monitoring of adherence coupled with case-management feedback, is
available in patient's preferred languages, and delivers electronic reminders. Likewise, behavior economic
(financial) incentives, in which patients receive incentives contingent on ingesting prescribed medications,
could mitigate financial stress associated with medical care and lost wages, a common concern among many
patients with latent TB infection. Adults with latent TB (N=399) will be randomized to a Usual Care Control, or
vDOT, or a vDOT Plus Incentives group. Usual Care Control participants will receive standard care for latent
TB. VDOT participants will receive the same Usual Care, but will use smartphones and a commercially
available application to receive electronic reminders, submit video-observations to document adherence, and
receive case-management real-time feedback. VDOT plus Incentives participants will receive further support
through contingent financial incentives (up to $35 per week) for taking prescribed medications under the vDOT
system. The primary outcome measure, completion of treatment for latent TB, will be assessed for all
participants through MEMS caps (Aim 1). We will also determine the costs, budgetary impact, and
incremental cost-effectiveness of the vDOT and vDOT plus incentives interventions (Aim 2). If this intervention
is effective in promoting completion of treatment for latent TB and is economically sound, it could prove to be a
scalable and effective intervention to promote completion of treatment for latent TB in high-risk populations in
Baltimore and in other populations around the world.

## Key facts

- **NIH application ID:** 10274703
- **Project number:** 1R01AI162888-01
- **Recipient organization:** JOHNS HOPKINS UNIVERSITY
- **Principal Investigator:** MAUNANK SHAH
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $811,650
- **Award type:** 1
- **Project period:** 2021-07-08 → 2026-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10274703

## Citation

> US National Institutes of Health, RePORTER application 10274703, Video DOT and Economic Incentives to promote adherence to LTBI therapy (1R01AI162888-01). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10274703. Licensed CC0.

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